If you live with pain almost every day, you’re not alone. An estimated 100 million adults suffer from chronic pain in the U.S., says the National Institutes of Health.
Chronic pain can be loosely defined as any pain that lasts more than three months. It has many symptoms and causes and has a wide array of possible treatments.
It can be a pain that accompanies an ongoing health condition, like arthritis, or a pain that persists beyond the usual recovery period after an illness, accident or surgery.
Chronic pain can come or go, or it may be constant. It may affect people to the point that they can’t work, eat properly, take part in physical activity, or enjoy life.
Peter Fliss, D.O., is a specialist in pain management at Sanford Bemidji Orthopedics and Sports Medicine. He is part of the interventional pain team in Bemidji, Minnesota, and most often works with people with lower back and neck pain, as well as peripheral joints and cancer-related pain.
The team’s ultimate goal is to help people feel better. They work to relieve painful symptoms in ways patients can sustain.
“We take a multidisciplinary approach here,” Dr. Fliss said. “Coming from multiple angles, we can hopefully help make patients’ pain more manageable and allow them to function more comfortably.”
What causes chronic pain?
Pain starts in nerve cells beneath the skin and in organs throughout the body. When you are sick, injured, or have other types of problems, these nerve cells send messages along nerve pathways to the spinal cord. This then carries the message to the brain.
There are many causes of chronic pain. It may have started from an illness or injury. You may have recovered from that, but pain remained. Or there may be an ongoing cause of pain, such as arthritis or cancer. Many people suffer chronic pain without having a past injury or illness.
Pain management doctors most often see patients with pain in the low back, knee, head, hip, and neck. Back pain, in particular, is often a source of problems.
“Most times pain symptoms come down to wear and tear,” Dr. Fliss said. “As time goes on, we develop arthritis in the back, just like we do every other joint. That can put pressure on different nerves and lead to pain that shoots down the legs.”
What are the symptoms of chronic pain?
Chronic pain symptoms may include:
- Mild to severe pain that does not go away as expected
- Pain that may be described as shooting, burning, aching, or electrical
- Mild pain, soreness, tightness, or stiffness
Chronic pain can affect almost all parts of your life. Your sleep, mood, activity, and energy level can all be disrupted by pain. Being tired, depressed, and out of shape can make the pain worse and harder to cope with.
When pain interferes with normal activities, you may go through what is called a “pain cycle.” You may become focused on the pain, which makes you depressed and irritable. This can lead to problems with sleeping (insomnia) and extreme tiredness (fatigue). That leads to more irritability, depression, and pain. This is the pain cycle.
The urge to stop the pain can make some people dependent on medicines. It may cause others to have repeated surgeries or try questionable treatments. This can often be as hard on the family as it is on the person who has the pain.
How is chronic pain diagnosed?
Your health care provider will review your health history, do a physical exam, and evaluate your pain. You will be asked some basic questions about your pain, such as:
- How long have you had this pain?
- Have you had pain like this before?
- Does it limit your daily activities? How?
- What are your goals for treating your pain?
- Is pain affecting your mood or causing anxiety or depression?
Depending on your answers to the questions and the results of a physical exam, you may have one or more diagnostic tests to help your provider find the cause of your pain.
X-rays and magnetic resonance imaging (MRI) are often used to find the source of the pain and provide insight into potential treatments.
“The MRI is the gold standard for showing if there’s a pinched nerve or a bulging disc,” Dr. Fliss said. “A lot of times it will present as a pain shooting down the legs and we’ll want to see an MRI to see exactly what we’re dealing with before we’ll do any kind of intervention.”
How is chronic pain treated?
Typically, chronic pain treatment starts with a conservative management plan. Before intervening with injections, for instance, Dr. Fliss will advise starting with over-the-counter medications like Tylenol, or non-steroidal anti-inflammatory drugs like ibuprofen.
“A lot of times a flare-up of chronic pain will improve on its own but sometimes it doesn’t,” Dr. Fliss said. “It often comes down to arthritis. Anti-inflammatories are typically good for that.”
Dr. Fliss recommends staying active as an effective tool in combating arthritis. It can include strengthening the lower back and core. Low impact exercises and yoga can also help.
“On the internet you can typically find yoga classes without having to spend a ton of money and you can do them on your own time,” Dr. Fliss said. “Even if we’ve done an injection or a procedure it’s important to stay active afterward.”
Several different types of medicines may be prescribed for chronic pain. Medicines may include:
- Over-the-counter medicines. These may include nonsteroidal anti-inflammatory drugs, aspirin, ibuprofen, or acetaminophen.
- Injections. These include steroid injections.
- Prescription pain medicines. These include opioids, which may be needed for stronger pain relief than over-the-counter medicines. But these medicines are used only for more severe types of pain. These medicines can be abused. They may also have unpleasant and possibly dangerous side effects.
- Prescription antidepressants. These medicines can help by increasing the supply of the naturally produced neurotransmitters, serotonin and norepinephrine. Serotonin is an important part of a pain-controlling pathway in the brain.
Other types of treatment include:
- Physical therapy. This involves different treatments, such as exercises and stretching. These can help reduce certain types of chronic pain.
- Occupational therapy. This teaches you how to do routine tasks of daily living in ways that can help reduce your pain.
- Heat and cold treatments. These can reduce stiffness and pain, especially with joint problems, such as arthritis.
- Local electrical stimulation. Short pulses of electricity on nerve endings under the skin give pain relief.
- Other therapies. Meditation, yoga, biofeedback, massage, and acupuncture can also help manage chronic pain.
Counseling can help you cope better with stress and pain. Emotional and psychological support for pain can also include group therapy, relaxation training and meditation.
Lifestyle behaviors – such as eating right, exercising, and stopping smoking – can also help reduce chronic pain.
“When I see someone at the clinic, I try to explain that when you’re 80 years old, you’re not going to leave the clinic feeling like you’re 20,” Dr. Fliss said. “We try to set realistic expectations. It’s often a multidisciplinary approach that can include therapy and your primary provider.”
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